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Sands A, Santiago MT, Uduwana S, Glater-Welt L, Ezhuthachan ID, Coscia G, Hayes L, Berry GJ, Rubin LG, Hagmann SHF. Congenital Tuberculosis After In Vitro Fertilization: A Case for Tuberculosis Screening of Women Evaluated for Infertility. Clin Infect Dis 2023; 76:e982-e986. [PMID: 35788281 DOI: 10.1093/cid/ciac542] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/12/2022] Open
Abstract
We report a case of multidrug-resistant congenital tuberculosis (TB) in an infant conceived by in vitro fertilization and review 22 additional infant-mother pairs in the literature. Females evaluated for infertility should be screened for TB risk, and those at risk require a TB-specific diagnostic evaluation before receiving assisted reproductive treatment.
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Affiliation(s)
- Ashley Sands
- Division of Pediatric Infectious Diseases.,Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health and Long Island Jewish Medical Center/Northwell, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York, USA
| | - Maria T Santiago
- Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health and Long Island Jewish Medical Center/Northwell, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York, USA.,Division of Pediatric Pulmonary Medicine
| | | | - Lily Glater-Welt
- Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health and Long Island Jewish Medical Center/Northwell, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York, USA.,Division of Pediatric Critical Care Medicine
| | - Idil D Ezhuthachan
- Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health and Long Island Jewish Medical Center/Northwell, New Hyde Park, New York, USA.,Division of Allergy and Immunology
| | - Gina Coscia
- Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health and Long Island Jewish Medical Center/Northwell, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York, USA.,Division of Allergy and Immunology
| | - Lisa Hayes
- Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health and Long Island Jewish Medical Center/Northwell, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York, USA.,Division of Infectious Diseases
| | - Gregory J Berry
- Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York, USA.,Division of Infectious Disease Diagnostics, Northwell Health Laboratories, Little Neck, New York, USA
| | - Lorry G Rubin
- Division of Pediatric Infectious Diseases.,Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health and Long Island Jewish Medical Center/Northwell, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York, USA
| | - Stefan H F Hagmann
- Division of Pediatric Infectious Diseases.,Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health and Long Island Jewish Medical Center/Northwell, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York, USA
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Zhang F, Zhang XF, Zhou HY. Clinical characteristics in 26 children with congenital tuberculosis in Central Southern China: a retrospective study. Paediatr Int Child Health 2022; 42:127-132. [PMID: 37587754 DOI: 10.1080/20469047.2023.2246006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Congenital tuberculosis (CTB) is relatively rare and most patients are described in case reports. AIM To investigate the clinical characteristics of CTB in 26 children. METHODS A retrospective analysis of 26 children with CTB from January 2013 to December 2021 in Changsha Central Hospital in Central Southern China was undertaken. RESULTS The median age at onset was 25 days (17-33) and within 4 weeks of age in approximately 73% of cases. Of 24 mothers (including two mothers of twins), 18 (75.0%) were asymptomatic during pregnancy, and four were diagnosed with tuberculosis prenatally. The numbers of tuberculous meningitis, tuberculous encephalitis and liver TB were 17 (65.4%), five (19.2%) and four (15.4%), respectively. The main symptoms were fever (n = 18, 69.2%) and cough (n = 16, 61.5%). Positive rates of T-SPOT.TB, acid-fast bacilli smear, culture of Mycobacterium tuberculosis and GeneXpert MTB/RIF test were, respectively, 84.2% (16/19), 42.3% (11/26), 43.5% (10/23) and 83.3% (5/6). Radiograph or computed tomography demonstrated typical pulmonary tuberculous lesions in all cases and the head magnetic resonance imaging (MRI) showed marked meningeal enhancement or parenchymal lesions in seven cases (26.9%). One case had drug-resistant TB. During follow-up, nine cases had varying degrees of liver injury, and one had delayed growth and development. Eight died and 18 recovered satisfactorily. CONCLUSION Maternal TB status during pregnancy, the epidemiological history, T-SPOT.TB and other TB-related aetiological tests and imaging are important for the early diagnosis and treatment of CTB, and are associated with a favourable outcome. ABBREVIATIONS AFB: acid-fast bacilli; Amk: amikacin; Cs: cycloserine; CT: computed tomography; E: ethambutol; GeneXpert MTB/RIF: GeneXpert Mycobacterium tuberculosis and rifampicin resistance; H: isoniazid; IVF-ET: in-vitro fertilization-embryo transfer; Lzd: linezolid; Mfx: moxifloxacin; MTB: Mycobacterium tuberculosis; mNGS: next generation sequencing; MTB-DNA: Mycobacterium tuberculosis-deoxyribonucleic acid; Pto: protionamide; R: rifampicin; TB: tuberculosis; T-SPOT.TB: spot test of mycobacterium TB infection T-lymphocytes; Z: pyrazinamide.
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Affiliation(s)
- Feng Zhang
- Department of Paediatric Tuberculosis, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Xiao-Fo Zhang
- Department of Paediatric Tuberculosis, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hai-Yi Zhou
- Department of Paediatric Tuberculosis, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Venturini E, Montagnani C, Boldrini A, Moroni M, Chiappini E, de Martino M, Galli L. Congenital tuberculosis after in vitro fertilization presenting with endobronchial granuloma. Pediatr Neonatol 2019; 60:105-107. [PMID: 29724565 DOI: 10.1016/j.pedneo.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 10/28/2017] [Accepted: 02/02/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Elisabetta Venturini
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
| | - Carlotta Montagnani
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
| | - Antonio Boldrini
- U.O. Neonatology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Marco Moroni
- Neonatal Intensive Care Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
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Yeh JJ, Lin SC, Lin WC. Congenital Tuberculosis in a Neonate: A Case Report and Literature Review. Front Pediatr 2019; 7:255. [PMID: 31294005 PMCID: PMC6598396 DOI: 10.3389/fped.2019.00255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/05/2019] [Indexed: 11/13/2022] Open
Abstract
Congenital tuberculosis (TB) is difficult to detect because the disease presents few or no symptoms in the fetus during pregnancy and nonspecific symptoms in neonates. We reviewed 20 cases of congenital TB reported between 2011 and 2017 and report a case of a mother and her 8 days old neonate with congenital TB. In these 21 cases (including our case), the most common clinical presentations were respiratory distress, fever, and hepatosplenomegaly. The most common chest imaging findings were pneumonia, multiple pulmonary nodules, and miliary pattern. The mortality rate of infants with TB was increased ~2.2-fold if their mothers had no symptoms. The case reported herein concerns an 8 days old neonate with the rare presentation of a 2 days history of fever, followed by abdominal distension without respiratory symptoms. Computed tomography (CT) imaging exhibited a large amount of right pleural effusion. Multiple antimicrobial therapies were administered to the neonate; however, his symptoms persisted. Repeat CT was used to identify a progressed disease with multiple nodules over the lung, spleen, and hepatic hilar region. Standard anti-TB medications were prescribed, and the patient recovered gradually. Both gastric lavage and pleural effusion cultures confirmed the diagnosis of TB. The neonate's mother denied any TB contact history and the diagnosis of any medical disease during pregnancy, but she experienced a fulminant course of miliary TB and was admitted to the intensive care unit 24 days postpartum. She died despite receiving anti-TB treatment. In TB-endemic areas, congenital TB should be taken into consideration when neonates develop fever, respond poorly to antimicrobial treatment, and when their mothers deny any TB contact history.
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Affiliation(s)
- Jui-Ju Yeh
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Chieh Lin
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chuan Lin
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Infection Control Office, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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Zhang X, Zhuxiao R, Xu F, Zhang Q, Yang H, Chen L, Liu F, Yang J. Congenital tuberculosis after in vitro fertilization: suggestion for tuberculosis tests in infertile women in developing countries. J Int Med Res 2018; 46:5316-5321. [PMID: 30453806 PMCID: PMC6300949 DOI: 10.1177/0300060518808179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Congenital tuberculosis (CTB) after in vitro fertilization (IVF) is a major new problem in developing countries. Only 16 cases of CTB after IVF have been reported, and no tuberculosis (TB) tests were performed before IVF in these cases. However, on the basis of data in the literature and from the World Health Organization, the incidence of CTB has been substantially underestimated. We describe two cases of CTB after IVF in detail in our center and provide new insight into the important issue of controlling TB vertical transmission in developing countries. Performing an early diagnosis of CTB, mostly based on evidence of maternal infection and a high index of clinical suspicion, is a challenge. However, most mothers have no symptoms of TB infection during prepartum, and infertility may be the only symptom. Infertility caused by genital TB is common in countries with a high TB burden, and IVF is considered to be an effective treatment to improve their fertility. Therefore, this may lead to more CTB cases without thorough TB tests before IVF. We suggest that thorough TB tests should be conducted in infertile women before IVF to prevent CTB.
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Affiliation(s)
- Xiaoling Zhang
- 1 Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
| | - Ren Zhuxiao
- 1 Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
| | - Fang Xu
- 1 Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
| | - Qi Zhang
- 2 Department of Clinical Genetic center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
| | - Haoming Yang
- 1 Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
| | - Liang Chen
- 3 Centre for Tuberculosis Control of Guangdong Province, Guangdong, 510630, China
| | - Fenghua Liu
- 4 Department of Assisted Reproductive Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
| | - Jie Yang
- 1 Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
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A Perspective of the Diagnosis and Management of Congenital Tuberculosis. J Pathog 2016; 2016:8623825. [PMID: 27999684 PMCID: PMC5143719 DOI: 10.1155/2016/8623825] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/03/2016] [Indexed: 01/01/2023] Open
Abstract
Tuberculosis continues to be a prevalent disease in the world and a global public health issue in many countries. The disease is more complicated in pregnant women because it imperils unborn offspring and results in congenital tuberculosis later if undiagnosed and untreated. Congenital tuberculosis is rare entity and an uncommon disease along with a high mortality rate. Congenital tuberculosis, a severe clinical type of tuberculosis caused by Mycobacterium tuberculosis, is a serious and fatal disease if left untreated. Our study emphasizes that it is necessary and mandatory to consider congenital tuberculosis in the differential diagnosis of neonatal or pulmonary infections in infants, essentially in countries where the incidence of tuberculosis is high burden. Mother to neonatal transmission of disease is well known via transplacental transmission through the umbilical vein to the fetus, through the ingestion of infected amniotic fluid. Early detection is challenging, because of the nonspecific nature of the signs and symptoms in tuberculosis during pregnancy and infancy. The degree of clinical suspicion is the essential component of diagnosis. Furthermore, it generally has a difficult treatment and it should not be delayed while waiting for diagnostic test results. Prompt identification and proper treatment regimens for congenital tuberculosis strongly relate with enhanced outcomes.
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